A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are paramedics. In some English-speaking countries, there is an official distinction between paramedics and
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
s (or
emergency care assistant
An emergency care assistant (ECA) is a type of NHS ambulance service worker in the United Kingdom, often used to support paramedics in responding to emergency calls.
This frontline staff role was introduced in 2006 as part of the modernisation of ...
s), in which paramedics have additional educational requirements and scope of practice.
Duties and functions
The paramedic role is closely related to other healthcare positions, especially the
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
, with paramedics often being at a higher grade with more responsibility and autonomy following substantially greater education and training. The primary role of a paramedic is to stabilize people with life-threatening injuries and transport these patients to a higher level of care (typically an emergency department). Due to the nature of their job, paramedics work in many environments, including roadways, people's homes, and depending on their qualifications, wilderness environments, hospitals, aircraft, and with SWAT teams during police operations. Paramedics also work in non-emergency situations, such as transporting chronically ill patients to and from treatment centers and in some areas, address social determinants of health and provide in-home care to ill patients at risk of hospitalization (a practice known as community paramedicine).
The role of a paramedic varies widely across the world, as EMS providers operate with many different models of care. In the Anglo-American model, paramedics are autonomous decision-makers. In some countries such as the United Kingdom and South Africa, the paramedic role has developed into an autonomous health profession. In the Franco-German model, ambulance care is led by physicians. In some versions of this model, such as France, there is no direct equivalent to a paramedic. Ambulance staff have either the more advanced qualifications of a physician or less advanced training in
first aid
First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial in ...
. In other versions of the Franco-German model, such as Germany, paramedics do exist. Their role is to support a physician in the field, in a role more akin to a hospital nurse, rather than operating with clinical autonomy.
The development of the profession has been a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospitalisation entirely and, through practitioners, are able to prescribe certain
medications
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital.
Occupational hazards
Paramedics are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling equipment, implementing a training program to educate paramedics on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards.
Infectious disease has become a major concern, in light of the
COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identif ...
. In response, the U.S.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
and other agencies and organizations have issued guidance regarding
workplace hazard controls for COVID-19
Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of COVID-19. Vaccination is the most effective way to protect against severe illness or death f ...
. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols. Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for paramedics when transporting sick patients capable of airborne transmission. Unidirectional airflow design can better protect workers.
History
Early history
Throughout the evolution of pre-hospitalisation care, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the Imperial Legions of Rome, where aging
Centurion
A centurion (; la, centurio , . la, centuriones, label=none; grc-gre, κεντυρίων, kentyríōn, or ) was a position in the Roman army during classical antiquity, nominally the commander of a century (), a military unit of around 80 ...
s, no longer able to fight, were given the task of organizing the removal of the wounded from the
battle
A battle is an occurrence of combat in warfare between opposing military units of any number or size. A war usually consists of multiple battles. In general, a battle is a military engagement that is well defined in duration, area, and force ...
field and providing some form of care. Such individuals, although not
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
s, were probably among the world's earliest
surgeon
In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
s by default, being required to suture wounds and complete
amputation
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...
s. A similar situation existed in the
Crusades
The Crusades were a series of religious wars initiated, supported, and sometimes directed by the Latin Church in the medieval period. The best known of these Crusades are those to the Holy Land in the period between 1095 and 1291 that were in ...
, with the
Knights Hospitaller
The Order of Knights of the Hospital of Saint John of Jerusalem ( la, Ordo Fratrum Hospitalis Sancti Ioannis Hierosolymitani), commonly known as the Knights Hospitaller (), was a medieval and early modern Catholic Church, Catholic Military ord ...
of the
Order of St. John of Jerusalem
The Order of Knights of the Hospital of Saint John of Jerusalem ( la, Ordo Fratrum Hospitalis Sancti Ioannis Hierosolymitani), commonly known as the Knights Hospitaller (), was a medieval and early modern Catholic Church, Catholic Military ord ...
filling a similar function; this organisation continued, and evolved into what is now known throughout the
Commonwealth of Nations
The Commonwealth of Nations, simply referred to as the Commonwealth, is a political association of 56 member states, the vast majority of which are former territories of the British Empire. The chief institutions of the organisation are the Co ...
Order of Malta Ambulance Corps
The Order of Malta Ireland – Ambulance Corps is a voluntary ambulance and first aid organisation operating in Ireland in affiliation with the Sovereign Military Order of Malta, founded in 1938.
Its purposes include teaching first aid, providi ...
in the Republic of Ireland and various countries.
Early ambulance services
While civilian communities had organized ways to deal with prehospitalisation care and transportation of the sick and dying as far back as the
bubonic plague
Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well a ...
in
London
London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...
between 1598 and 1665, such arrangements were typically ''ad hoc'' and temporary. In time, however, these arrangements began to formalize and become permanent. During the
American Civil War
The American Civil War (April 12, 1861 – May 26, 1865; also known by other names) was a civil war in the United States. It was fought between the Union ("the North") and the Confederacy ("the South"), the latter formed by states th ...
,
Jonathan Letterman
Major Jonathan Letterman (December 11, 1824 – March 15, 1872) was an American surgeon credited as being the originator of the modern methods for medical organization in armies or battlefield medical management. In the United States, Letterman i ...
devised a system of mobile
field hospital
A field hospital is a temporary hospital or mobile medical unit that takes care of casualties on-site before they can be safely transported to more permanent facilities. This term was initially used in military medicine (such as the Mobile A ...
s employing the first uses of the principles of
triage
In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...
. After returning home, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, and commenced the creation of volunteer life-saving squads and ambulance corps.
These early developments in formalized ambulance services were decided at local levels, and this led to services being provided by diverse operators such as the local hospital, police, fire brigade, or even
funeral director
A funeral director, also known as an undertaker (British English) or mortician (American English), is a professional involved in the business of funeral rites. These tasks often entail the embalming and burial or cremation of the dead, as w ...
s who often possessed the only local transport allowing a passenger to lie down. In most cases these ambulances were operated by drivers and attendants with little or no medical training, and it was some time before formal training began to appear in some units. An early example was the members of the Toronto Police Ambulance Service receiving a mandatory five days of training from St. John as early as 1889.
Prior to
World War I
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
motorized ambulances started to be developed, but once they proved their effectiveness on the battlefield during the war the concept spread rapidly to civilian systems. In terms of advanced skills, once again the military led the way. During
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
and the
Korean War
, date = {{Ubl, 25 June 1950 – 27 July 1953 (''de facto'')({{Age in years, months, weeks and days, month1=6, day1=25, year1=1950, month2=7, day2=27, year2=1953), 25 June 1950 – present (''de jure'')({{Age in years, months, weeks a ...
battlefield medics administered painkilling
narcotic
The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "to make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...
s by injection in emergency situations, and pharmacists' mates on warships were permitted to do even more without the guidance of a physician. The Korean War also marked the first widespread use of
helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
s to evacuate the wounded from forward positions to medical units, leading to the rise of the term "
medevac
Medical evacuation, often shortened to medevac or medivac, is the timely and efficient movement and en route care provided by medical personnel to wounded being evacuated from a battlefield, to injured patients being evacuated from the scene of a ...
". These innovations would not find their way into the civilian sphere for nearly twenty more years.
Prehospital emergency medical care
By the early 1960s experiments in improving medical care had begun in some civilian centres. One early experiment involved the provision of pre-hospital
cardiac
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
care by physicians in
Belfast
Belfast ( , ; from ga, Béal Feirste , meaning 'mouth of the sand-bank ford') is the capital and largest city of Northern Ireland, standing on the banks of the River Lagan on the east coast. It is the 12th-largest city in the United Kingdo ...
, Northern Ireland, in 1966. This was repeated in
Toronto
Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...
, Canada in 1968 using a single ambulance called ''Cardiac One'', which was staffed by a regular ambulance crew, along with a hospital
intern
An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used practice for a wide range of placements in businesses, non-profit organizations and gover ...
to perform the advanced procedures. While both of these experiments had certain levels of success, the technology had not yet reached a sufficiently advanced level to be fully effective; for example, the Toronto portable
defibrillator
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''coun ...
and
heart monitor
A heart rate monitor (HRM) is a personal monitoring device that allows one to measure/display heart rate in real time or record the heart rate for later study. It is largely used to gather heart rate data while performing various types of ph ...
was powered by lead-acid car batteries, and weighed around .
In 1966, a report called ''Accidental Death and Disability: The Neglected Disease of Modern Society''—commonly known as ''
The White Paper ''Accidental Death and Disability: The Neglected Disease of Modern Society'' is a 1966 report by the United States National Academy of Sciences, National Academy of Sciences. It is considered a landmark in the development of the Emergency medical se ...
''—was published in the United States. This paper presented data showing that soldiers who were seriously wounded on the battlefields during the
Vietnam War
The Vietnam War (also known by #Names, other names) was a conflict in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. It was the second of the Indochina Wars and was officially fought between North Vie ...
had a better survival rate than individuals who were seriously injured in motor vehicle accidents on
California
California is a U.S. state, state in the Western United States, located along the West Coast of the United States, Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the List of states and territori ...
's
freeway
A controlled-access highway is a type of highway that has been designed for high-speed vehicular traffic, with all traffic flow—ingress and egress—regulated. Common English terms are freeway, motorway and expressway. Other similar terms ...
s. Key factors contributing to victim survival in transport to definitive care such as a hospital were identified as comprehensive trauma care, rapid transport to designated trauma facilities, and the presence of medical corpsmen who were trained to perform certain critical advanced medical procedures such as fluid replacement and
airway management
Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...
.
As a result of ''The White Paper'', the US government moved to develop minimum standards for ambulance training, ambulance equipment and vehicle design. These new standards were incorporated into Federal Highway Safety legislation and the states were advised to either adopt these standards into state laws or risk a reduction in Federal highway safety funding. The "White Paper" also prompted the inception of a number of emergency medical service (EMS) pilot units across the US including paramedic programs. The success of these units led to a rapid transition to make them fully operational.
Freedom House Ambulance Service was the first civilian emergency medical service in the United States to be staffed by
paramedics
A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are p ...
, most of whom were black.
New York City's Saint Vincent's Hospital developed the United States' first Mobile Coronary Care Unit (MCCU) under the medical direction of William Grace, MD, and based on Frank Pantridge's MCCU project in Belfast, Northern Ireland. In 1967, Eugene Nagle, MD and Jim Hirschmann, MD helped pioneer the United States' first EKG telemetry transmission to a hospital and then in 1968, a functional paramedic program in conjunction with the City of Miami Fire Department. In 1969, the City of Columbus Fire Services joined with the Ohio State University Medical Center to develop the "HEARTMOBILE" paramedic program under the medical direction of James Warren, MD and Richard Lewis, MD. In 1969, the Haywood County (NC) Volunteer Rescue Squad developed a paramedic program (then called Mobile Intensive Care Technicians) under the medical direction of Ralph Feichter, MD. In 1969, the initial Los Angeles paramedic training program was instituted in conjunction with Harbor General Hospital, now
Harbor–UCLA Medical Center
Harbor–UCLA Medical Center, is a 570-bed public teaching hospital located at 1000 West Carson Street in West Carson, an unincorporated area within Los Angeles County, California. As implied by the name, the hospital is owned by the Los Angeles ...
, under the medical direction of
J. Michael Criley
John Michael Criley, MD, FACC, MACP, (born 1931) is Professor Emeritus at the David Geffen School of Medicine at University of California, Los Angeles (UCLA).
Biography
He has made a number of pioneering contributions to the field of cardiology ...
, MD and James Lewis, MD. In 1969, the Seattle "Medic 1" paramedic program was developed in conjunction with the Harborview Medical Center under the medical direction of Leonard Cobb, MD. The Marietta (GA) initial paramedic project was instituted in the Fall of 1970 in conjunction with Kennestone Hospital and Metro Ambulance Service, Inc. under the medical direction of Luther Fortson, MD. The Los Angeles County and City established paramedic programs following the passage of ''The Wedsworth-Townsend Act'' in 1970. Other cities and states passed their own paramedic bills, leading to the formation of services across the US. Many other countries also followed suit, and paramedic units formed around the world.
In the military, however, the required
telemetry
Telemetry is the in situ data collection, collection of measurements or other data at remote points and their automatic data transmission, transmission to receiving equipment (telecommunication) for monitoring. The word is derived from the Gr ...
and
miniaturization
Miniaturization ( Br.Eng.: ''Miniaturisation'') is the trend to manufacture ever smaller mechanical, optical and electronic products and devices. Examples include miniaturization of mobile phones, computers and vehicle engine downsizing. In ele ...
technologies were more advanced, particularly due to initiatives such as the space program. It would take several more years before these technologies drifted through to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and sometimes still operate, in
Europe
Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
an countries and
Latin America
Latin America or
* french: Amérique Latine, link=no
* ht, Amerik Latin, link=no
* pt, América Latina, link=no, name=a, sometimes referred to as LatAm is a large cultural region in the Americas where Romance languages — languages derived f ...
.
Public notability
While doing background research at Los Angeles'
UCLA
The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California St ...
Harbor Medical Center for a proposed new show about doctors,
television producer
A television producer is a person who oversees one or more aspects of video production on a television show, television program. Some producers take more of an executive role, in that they conceive new programs and pitch them to the television net ...
Robert A. Cinader
Robert A. Cinader (November 10, 1924 – November 16, 1982) was an American television producer best known for his work on two NBC series packaged by actor/producer Jack Webb's Mark VII Limited, '' Adam-12'' and ''Emergency!'' The latter show in ...
, working for
Jack Webb
John Randolph Webb (April 2, 1920 – December 23, 1982) was an American actor, television producer, Television director, director, and screenwriter, who is most famous for his role as Joe Friday, Sgt. Joe Friday in the Dragnet (franchise) ...
, happened to encounter "firemen who spoke like doctors and worked with them". This concept developed into the television series '' Emergency!'', which ran from 1972 to 1977, portraying the exploits of this new profession called paramedics. The show gained popularity with emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were just six paramedic units operating in three pilot programs in the whole of the US, and the term paramedic was essentially unknown. By the time the program ended in 1977, there were paramedics operating in all fifty states. The show's
technical advisor
In film production, a technical advisor is someone who advises the director on the convincing portrayal of a subject. The advisor's expertise adds realism both to the acting and to the setting of a movie.
Nipo T. Strongheart
Nipo T. Stronghear ...
,
James O. Page
James O. Page JD (August 7, 1936 – September 4, 2004) was recognized as a leading authorityparamedicine and responsible for the UCLA paramedic program; he would go on to help establish paramedic programs throughout the US, and was the founding publisher of the ''Journal of Emergency Medical Services'' (''JEMS''). The ''JEMS'' magazine creation resulted from Page's previous purchase of the ''PARAMEDICS International'' magazine.
Ron Stewart
Ronald George Stewart (July 11, 1932 – March 17, 2012) was a Canadian professional ice hockey player in the National Hockey League (NHL) from 1952 to 1973, as well as a coach. He spent the first half of his career with the Toronto Maple Leafs, ...
, the show's
medical director
A medical director is a physician who provides guidance and leadership on the use of medicine in a healthcare organization. These include the emergency medical services, hospital departments, blood banks, clinical teaching services and others. A m ...
, was instrumental in organizing emergency health services in southern California earlier in his career during the 1970s, in the paramedic program in Pittsburgh, and had a substantial role in the founding of the paramedic programs in Toronto and
Nova Scotia
Nova Scotia ( ; ; ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the four Atlantic provinces. Nova Scotia is Latin for "New Scotland".
Most of the population are native Eng ...
, Canada.
Evolution and growth
Throughout the 1970s and 1980s, the paramedic field continued to evolve, with a shift in emphasis from patient transport to treatment both on scene and en route to hospitals. This led to some services changing their descriptions from "ambulance services" to "
emergency medical services
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
".
The training, knowledge-base, and skill sets of both paramedics and emergency medical technicians (EMTs) were typically determined by local medical directors based primarily on the perceived needs of the community along with affordability. There were also large differences between localities in the amount and type of training required, and how it would be provided. This ranged from in-service training in local systems, through community colleges, and up to university level education. This emphasis on increasing qualifications has followed the progression of other health professions such as
nursing
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...
, which also progressed from on the job training to university level qualifications.
The variations in educational approaches and standards required for paramedics has led to large differences in the required qualifications between locations—both within individual countries and from country to country. Within the UK training is a three-year course equivalent to a
bachelor's degree
A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to six ...
. Comparisons have been made between Paramedics and nurses; with nurses now requiring degree entry (BSc) the knowledge deficit is large between the two fields. This has led to many countries passing laws to protect the title of "paramedic" (or its local equivalent) from use by anyone except those qualified and experienced to a defined standard. This usually means that paramedics must be registered with the appropriate body in their country; for example all paramedics in the United Kingdom must by registered with the
Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
(HCPC) in order to call themselves a paramedic. In the United States, a similar system is operated by the National Registry of Emergency Medical Technicians (NREMT), although this is only accepted by forty of the fifty states.
As paramedicine has evolved, a great deal of both the
curriculum
In education, a curriculum (; : curricula or curriculums) is broadly defined as the totality of student experiences that occur in the educational process. The term often refers specifically to a planned sequence of instruction, or to a view ...
and skill set has existed in a state of flux. Requirements often originated and evolved at the local level, and were based upon the preferences of physician advisers and medical directors. Recommended treatments would change regularly, often changing more like a fashion than a scientific discipline. Associated technologies also rapidly evolved and changed, with medical equipment manufacturers having to adapt equipment that worked inadequately outside of hospitals, to be able to cope with the less controlled pre-hospital environment.
Physicians began to take more interest in paramedics from a research perspective as well. By about 1990, the fluctuating trends began to diminish, being replaced by outcomes-based research. This research then drove further evolution of the practice of both paramedics and the emergency physicians who oversaw their work, with changes to procedures and protocols occurring only after significant research demonstrated their need and effectiveness (an example being
ALS
Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or Lou Gehrig's disease, is a neurodegenerative disease that results in the progressive loss of motor neurons that control voluntary muscles. ALS is the most com ...
). Such changes affected everything from simple procedures such as
CPR
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore sponta ...
, to changes in drug protocols. As the profession grew, some paramedics went on to become not just research participants, but researchers in their own right, with their own projects and journal publications. In 2010, the American Board of Emergency Medicine created a
medical subspecialty
A subspecialty (US English) or subspeciality (international English) is a narrow field of professional knowledge/skills within a specialty of trade, and is most commonly used to describe the increasingly more diverse medical specialties. A subspe ...
for physicians who work in emergency medical services.
Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the early days medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. While this still occurs in some jurisdictions, it has become increasingly rare. Day-to-day operations largely moved from direct and immediate medical control to pre-written protocols or standing orders, with the paramedic typically seeking advice after the options in the standing orders had been exhausted.
Canada
While the evolution of paramedicine described above is focused largely on the US, many other countries followed a similar pattern, although often with significant variations. Canada, for example, attempted a pilot paramedic training program at
Queen's University Queen's or Queens University may refer to:
*Queen's University at Kingston, Ontario, Canada
*Queen's University Belfast, Northern Ireland, UK
**Queen's University of Belfast (UK Parliament constituency) (1918–1950)
**Queen's University of Belfast ...
,
Kingston, Ontario
Kingston is a city in Ontario, Canada. It is located on the north-eastern end of Lake Ontario, at the beginning of the St. Lawrence River and at the mouth of the Cataraqui River (south end of the Rideau Canal). The city is midway between Toro ...
, in 1972. The program, which intended to upgrade the then mandatory 160 hours of training for ambulance attendants, was found to be too costly and premature. The program was abandoned after two years, and it was more than a decade before the legislative authority for its graduates to practice was put into place. An alternative program which provided 1,400 hours of training at the
community college
A community college is a type of educational institution. The term can have different meanings in different countries: many community colleges have an "open enrollment" for students who have graduated from high school (also known as senior sec ...
level prior to commencing employment was then tried, and made mandatory in 1977, with formal certification examinations being introduced in 1978. Similar programs occurred at roughly the same time in
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
and
British Columbia
British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
, with other Canadian provinces gradually following, but with their own education and certification requirements. Advanced Care Paramedics were not introduced until 1984, when
Toronto
Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...
trained its first group internally, before the process spread across the country. By 2010 the Ontario system involved a two-year community college based program, including both hospital and field clinical components, prior to designation as a Primary Care Paramedic, although it is starting to head towards a university degree-based program. The province of Ontario announced that by September 2021, the entry level primary care paramedic post-secondary program would be enhanced from a two-year diploma to a three-year advanced diploma in primary care paramedicine. Resultantly, advanced care paramedics in Ontario will require a minimum of four years of post-secondary education and critical care paramedics will require five years of post-secondary education.
Israel
In Israel, paramedics are trained in either of the following ways: a three-year degree in Emergency Medicine (B.EMS), a year and three months
IDF
IDF or idf may refer to:
Defence forces
* Irish Defence Forces
* Israel Defense Forces
*Iceland Defense Force, of the US Armed Forces, 1951-2006
* Indian Defence Force, a part-time force, 1917
Organizations
* Israeli Diving Federation
* Interac ...
training, or
MADA
Mada ( sa, मद) is a term used in both Āstika and nāstika, Hindu theology and Hindu mythology, mythology. It is one of the Arishadvargas. It refers to one of the six enemy of the mind or a vice according to the Hindu texts, Hindu scriptures ...
training. Paramedics manage and provide medical guidelines in
mass casualty incident
A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a ...
s. They operate in MED evac and ambulances. They are legalized under the 1976 Doctors Ordinance (Decree). In a 2016 study at the Ben Gurion University of the Negev it was found that 73% of trained paramedics stop working within a five-year period, and 93% stop treating within 10 years.
United Kingdom
In the United Kingdom, ambulances were originally
municipal
A municipality is usually a single administrative division having corporate status and powers of self-government or jurisdiction as granted by national and regional laws to which it is subordinate.
The term ''municipality'' may also mean the go ...
services after the end of World War II. Training was frequently conducted internally, although national levels of coordination led to more standardization of staff training. Ambulance services were merged into county-level agencies in 1974, and then into regional agencies in 2006. The regional ambulance services, most often trusts, are under the authority of the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
and there is now a significant standardization of training and skills.
The UK model has three levels of ambulance staff. In increasing order of clinical skill these are:
emergency care assistant
An emergency care assistant (ECA) is a type of NHS ambulance service worker in the United Kingdom, often used to support paramedics in responding to emergency calls.
This frontline staff role was introduced in 2006 as part of the modernisation of ...
s, ambulance technicians and paramedics.
The original route to becoming a paramedic was to join an NHS ambulance service and work towards the position from non-emergency patient transport roles through to the emergency division as a Qualified Ambulance Man/Woman and after qualifying those who wanted to increase their knowledge and skills joined the Association of Emergency Medical Technicians. This was an organisation run by members to promote and train Paramedics. The AEMT was supported by BASICS and large numbers of hospital doctors. Training took place at various locations in members off duty time and at their expense. Trainees followed a wide academic curriculum which led to a written exam. If successful they became Associates and entered the clinical phase of training. Attending hospitals they were trained in all the practical skills. The final examination was designed to put as much pressure on the candidate as possible. The hospital consultant would sign to say that he was happy for a passing candidate to treat their family.
In the 1970s some ambulance service training departments started offering advanced skill training under the direction of Peter Baskett (Consultant Anaesthetist at Frenchay Hospital, Bristol) and
Douglas Chamberlain
Douglas Anthony Chamberlain, (born 1931) is a British cardiologist who founded the first paramedic unit in Europe, revolutionising pre-hospital clinical care.
Early life
Chamberlain was born in Cardiff in 1931. His father was a coal merchant. H ...
(Consultant Cardiologist in Brighton). This was the inception of the paramedic service in the UK, and subsequently was developed across Europe. In 1986 the NHSTA introduced the certificate in Extended Ambulance Aid. Existing AEMT Paramedics were forced to sit a conversion examination. The curriculum for the new qualification was substantially smaller cutting out a lot of anatomy and physiology as well as pharmacology and obstetrics. In November 1986 the examinations took place with the first certificates issued alphabetically. The candidate with highest score received certificate 177 and was the only Paramedic at Huntingdon. Training was introduced the following year but due to costs the time was kept to a minimum. The AEMT folded in the 1990s as the training offered was no longer recognised by the ambulance services. Equipment owned by the branches was given to hospitals.
The NHS Training Authority, NHSTA, (which became the NHS Training Directorate and then the NHS Training Division, which in turn became the Institute of Health and Care Development. The institute was acquired by the Edexcel examination board in 1998, and Edexcel was acquired by Pearson in 2004. Pearson continued to operate the IHCD 'brand' until 2016. This 'in-house' paramedic training was a modular programme, usually between 10 and 12 weeks, followed by time spent in a hospital emergency department, coronary care centre and operating theatre, assisting the anaesthetist and performing airway management techniques such as endotracheal intubation. Completion of the course allowed the paramedic to register with the Council for Professions Supplementary to Medicine (CPSM), which was superseded by the Health and Care Professions Council (HCPC), a regulatory body. It is worth noting that this route also took around 3 years if undertaken as quickly as possible. After the non emergency training, initially an 8-week clinical technician course was undertaken, with 750 mentored hours. Staff usually had to be a qualified technician for 2 years before applying for paramedic training noted above, a further 750 hours mentored had to be undertaken to complete the paramedic course to practice and demonstrate the skills learnt during the hospital placements and residential course.
Prior to regulation and closure of the title, the term "paramedic" was used by a variety of people with varying levels of ability. Paramedics could apply to register via a grandfather scheme which ended in 2002.
However, university qualifications are expected for paramedics, with the entry level being an Honours
Bachelor of Science
A Bachelor of Science (BS, BSc, SB, or ScB; from the Latin ') is a bachelor's degree awarded for programs that generally last three to five years.
The first university to admit a student to the degree of Bachelor of Science was the University of ...
degree in Pre-Hospital Care or Paramedic Science. As the title "Paramedic" is legally protected, those utilising must be registered with the
Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
(HCPC), and in order to qualify for registration you must meet the standards for registration, which include having a degree obtained through an approved course.
It is common for paramedics to have master's degrees in Advanced practice or Paramedic practice and is indeed a requisite for paramedic prescribing.
Paramedics work in various settings including NHS and Independent Ambulance Providers, Air Ambulances, Emergency Departments and other alternative settings. Some paramedics have gone on to become ''Paramedic Practitioners'', a role that practices independently in the pre-hospital environment in a capacity similar to that of a nurse practitioner. This is a fully autonomous role, and such senior paramedics are now working in hospitals, community teams such as rapid response teams, and also in increasing numbers in general practice, where their role includes acute presentations, complex chronic care and end of life management. They work as part of the
allied health professional
Allied health professions are health care professions distinct from optometry, dentistry, nursing, medicine, and pharmacy. They provide a range of diagnostic, technical, therapeutic, and support services in connection with health care.
Definitio ...
team including Doctors, Nurses, physician Associates, Physiotherapists, Associate Physicians, Health Care Assistant and Clinical Pharmacists. Paramedic Practitioners also undertake examinations modelled upon the MRCGP (a combination of applied knowledge exams, clinical skills and work place based assessment) in order to use the title "specialist". There are also now a growing number of these advanced paramedics who are independent and supplementary prescribers. There are also 'Critical Care Paramedics' who specialise in acute emergency incidents. In 2018, the UK government changed legislation allowing Paramedics to independently prescribe, which will open new pathways to Paramedics to progress into. This came into force on 1 April 2018, but did not immediately affect practice as guidance was still being written.
United States
In the United States, the minimum standards for paramedic training is considered vocational, but many colleges offer paramedic
associate degree
An associate degree is an undergraduate degree awarded after a course of post-secondary study lasting two to three years. It is a level of qualification above a high school diploma, GED, or matriculation, and below a bachelor's degree.
The fi ...
or
bachelor's degree
A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to six ...
options. Paramedic education programs typically follow the U.S. NHTSA EMS Curriculum, DOT or National Registry of EMTs. While many regionally accredited
community college
A community college is a type of educational institution. The term can have different meanings in different countries: many community colleges have an "open enrollment" for students who have graduated from high school (also known as senior sec ...
s offer paramedic programs and two-year associate degrees, a handful of universities also offer a four-year bachelor's degree component. The national standard course minimum requires
didactic
Didacticism is a philosophy that emphasizes instructional and informative qualities in literature, art, and design. In art, design, architecture, and landscape, didacticism is an emerging conceptual approach that is driven by the urgent need to ...
and clinical hours for a paramedic program of 1,500 or more hours of classroom training and 500+ clinical hours to be accredited and nationally recognized. Calendar length typically varies from 12 months to upwards of two years, excluding degree options, EMT training, work experience, and prerequisites. It is required to be a certified Emergency Medical Technician prior to starting paramedic training. Entry requirements vary, but many paramedic programs also have prerequisites such as one year required work experience as an
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
, or anatomy and physiology courses from an accredited college or university. Paramedics in some states must attend up to 50+ hours of ongoing education, plus maintain Pediatric Advanced Life Support and Advanced Cardiac Life Support. National Registry requires 70 + hours to maintain its certification or one may re-certify through completing the written computer based adaptive testing again (between 90 and 120 questions) every two years.
Paramedicine continues to grow and evolve into a formal profession in its own right, complete with its own standards and body of knowledge, and in many locations paramedics have formed their own
professional bodies
A professional is a member of a profession or any person who works in a specified professional activity. The term also describes the standards of education and training that prepare members of the profession with the particular knowledge and skil ...
. The early technicians with limited training, performing a small and specific set of procedures, has become a role beginning to require a foundation degree in countries such as
Australia
Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...
,
South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, the UK, and increasingly in Canada and parts of the U.S. such as
Oregon
Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...
, where a degree is required for entry level practice.
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
". A paramedic is a person with at least junior bachelor degree in "Healthcare" field. For a person with basic nine-year school education, the term of training is four years (junior bachelor's degree equivalent); with 11 years of schooling - two years for junior bachelor or 3–4 years for bachelor's degrees.
Venezuela
In Venezuela, paramedic is a specific denomination for the assistance function of health professionals, with titles registered in the Autonomous Service of Registries and Notaries (SAREN) and/or Autonomous Service of Sanitary Comptrollership (SACS) of the Ministry of People's Power for Health (MPPS), Graduates (Lcdos) or Higher University Technicians (TSU) in Prehospital Emergencies (EPH) or Lcdos and/or TSU in Sub Area Endogenous Development (DESA) or mention in Prehospital Emergencies (EPH), Lcdos and/or TSU Firefighter in Prehospital Emergency, usually a member of an Emergency Medical Service (EMS or SEM), with its main objective "to provide primary and immediate care to people who are victims of accidents or sudden illness" in the Prehospital setting, sometimes following the doctor's guidelines specialist in emergency by biomedical transmission and telemedicine or by applying national and international protocols reviewed and accepted.
Paramedics are people specialized in critical situations5 who have Higher University Technician (TSU) and/or Bachelor of Prehospital Emergencies (EPH), or Sub Area Endogenous Development (DESA) Prehospital Emergencies, advanced studies of: (Higher Technician) Specialist (TSE) in Prehospital Medical Emergencies (EMPH), Master's Degree in Prehospital Emergencies, Master in Prehospital Medical Emergencies (Project being created by the Latin American and Caribbean University), granted by Higher Education Institutions (IES) such as the University Institutes of Technology (IUT) and Autonomous, Experimental or Private Universities approved for this purpose. itation needed
Its function, according to the provisions of spuesto en la normativa correspondiente, es "proporcionar atención primaria e inmediata a personas víctimas de accidentes o enfermedad repentina".
Employment
Paramedics are employed by a variety of different organizations, and the services they provide may occur under differing organizational structures, depending on the part of the world. A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively basic primary health care and assessment services.
Some paramedics have begun to specialize their practice, frequently in association with the environment in which they will work. Some early examples of this involved aviation medicine and the use of
helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
s, and the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses, and technicians for transporting patients, increasingly this role falls to specialized senior and experienced paramedics. Other areas of specialization include such roles as tactical paramedics working in police units, marine paramedics, hazardous materials ( Hazmat) teams,
Heavy Urban Search and Rescue
HUSAR is the Toronto Heavy Urban Search and Rescue unit CAN-TF3 - an urban search and rescue unit able to respond to disaster situations at a city, provincial and national level, as well as offer international assistance.
CAN-TF3 is operated by T ...
, and paramedics on offshore oil platforms, oil and mineral exploration teams, and in the
military
A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
.
The majority of paramedics are employed by the emergency medical service for their area, although this employer could itself be working under a number of models, including a specific autonomous public ambulance service, a fire department, a hospital based service, or a private company working under contract. In
Washington
Washington commonly refers to:
* Washington (state), United States
* Washington, D.C., the capital of the United States
** A metonym for the federal government of the United States
** Washington metropolitan area, the metropolitan area centered on ...
, firefighters have been offered free paramedic training. There are also many paramedics who volunteer for backcountry or wilderness rescue teams, and small town rescue squads. In the specific case of an ambulance service being maintained by a fire department, paramedics and EMTs may be required to maintain firefighting and rescue skills as well as medical skills, and vice versa. In some instances, such as
Los Angeles County
Los Angeles County, officially the County of Los Angeles, and sometimes abbreviated as L.A. County, is the most populous county in the United States and in the U.S. state of California, with 9,861,224 residents estimated as of 2022. It is the ...
, a fire department may provide emergency medical services, but as a rapid response or rescue unit rather than a transport ambulance.
The provision of municipal ambulance services and paramedics, can vary by area, even within the same country or state. For instance, in Canada, the province of British Columbia operates a province-wide service (the British Columbia Ambulance Service) whereas in
Ontario
Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
, the service is provided by each municipality, either as a distinct service, linked to the fire service, or contracted out to a third party.
Scope of Practice
Common skills
While there are varying degrees of training and expectations around the world, a set of skills practiced by paramedics in the pre-hospital setting commonly includes:
* Advanced cardiac life support, or ACLS, including
cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
,
defibrillation
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
,
cardioversion
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a sinus rhythm, normal rhythm using electricity or pharmaceutical drug, drugs. Synchronized electrical cardiover ...
, transcutaneous pacing, and administration of cardiac drugs
* Patient assessment, including acquisition of
vital signs
Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...
, physical exam,
chest auscultation
Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hear ...
capnography
Capnography is the monitoring of the concentration or partial pressure of carbon dioxide () in the respiratory gases. Its main development has been as a monitoring tool for use during anesthesia and intensive care. It is usually presented as a g ...
ultrasound
Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
and basic blood chemistry interpretation (glucose, lactate)
*Airway management techniques including
tracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer ce ...
,
cricothyrotomy
A cricothyrotomy (also called cricothyroidotomy) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or ...
,
rapid sequence induction
In advanced airway management, rapid sequence induction (RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) or as crash induction – is a special process for endotracheal intubation that is ...
,
supraglottic airway
Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...
insertion, manual repositioning, sterile suctioning, use of oropharyngeal and nasopharyngeal airway adjuncts, and manual removal of obstructions via direct laryngoscopy and use of
magill forceps
Magill forceps are angled forceps used to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision.Thorocostomy and pericardiocentesis to relieve pneumothorax and pericardial tamponade
*
Intravenous
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
(IV) and
intraosseous
Intraosseous infusion (IO) is the process of injecting medications, fluids, or blood products directly into the marrow of a bone; this provides a non-collapsible entry point into the systemic venous system. The intraosseous infusion technique i ...
(IO) cannulation
* Oxygen administration and
positive pressure ventilation
Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional pref ...
via
bag-valve-mask
A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide Modes of mechanical ventilation, positive pressure ventilation ...
,
CPAP
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ap ...
Fluid resuscitation
Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous ...
* Administration of emergency drugs/medications (see section below)
* Bleeding control and management of
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emerge ...
* Spinal injury management, including immobilization and safe transport
*
Fracture
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
management, including assessment, splinting, and dislocation reduction
*
Obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...
, including assessment,
childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...
, and recognition of and procedures for obstetrical emergencies such as
breech presentation
A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Due to their higher than average rate of possible complications for the ...
, cord presentation, and
placental abruption
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerou ...
* Management of burns, including classification, estimate of surface area, recognition of more serious burns, and treatment
* Triage of patients in a
mass casualty incident
A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a ...
* Surgical procedures such as field amputation, escharotomy, or
thorocotomy
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the hea ...
(if trained and credentialed)
Emergency Pharmacology
Paramedics carry and administer a wide array of emergency
medications
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
. The specific medications they are permitted to administer vary widely, based on local standards of care and protocols. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly. A representative list of medications may commonly include:
*
Analgesic
An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...
medications such as
aspirin
Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...
,
ketorolac
Ketorolac, sold under the brand names Toradol, and Biorolac among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain. Specifically it is recommended for moderate to severe pain. Recommended duration of treatment is less ...
Narcotic
The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "to make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...
s like
morphine
Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...
fentanyl
Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocaine ...
, and
methoxyflurane
Methoxyflurane, sold under the brand name Penthrox among others, is an inhaled medication primarily used to reduce pain following trauma. It may also be used for short episodes of pain as a result of medical procedures. Onset of pain relief is ...
, used to treat severe pain.
* Beta and calcium channel blockers such as
diltiazem
Diltiazem, sold under the brand name Cardizem among others, is a calcium channel blocker medication used to treat high blood pressure, angina, and certain heart arrhythmias. It may also be used in hyperthyroidism if beta blockers cannot be used ...
verapamil
Verapamil, sold under various trade names, is a calcium channel blocker medication used for the treatment of high blood pressure, angina (chest pain from not enough blood flow to the heart), and supraventricular tachycardia. It may also be used ...
used to slow down excessively high heart rates or severe
hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
*
Parasympatholytic A parasympatholytic agent is a substance or activity that reduces the activity of the parasympathetic nervous system. (The parasympathetic nervous system is often colloquially described as the "Feed and Breed" or "Rest and Digest" portion of the a ...
drug such as
Atropine
Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given i ...
, also known as anticholinergic drugs, used to speed up slow bradycardic heart rates
*
Sympathomimetics
Sympathomimetic drugs (also known as adrenergic drugs and adrenergic amines) are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system. Examples of sympathomimetic effects include increases in heart ...
such as
dopamine
Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
norepinephrine
Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as both a hormone and neurotransmitter. The name "noradrenaline" (from Latin '' ad'', ...
, and
epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
used for
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
, severe
hypotension
Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dias ...
(low blood pressure),
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emerge ...
and
sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
. These are often known as "vasoactive" agents.
*
Dextrose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
(often D50W, a solution of 50% dextrose in water), used to treat
hypoglycemia
Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose belo ...
(low blood sugar)
*
Sedative
A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but t ...
lorazepam
Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and c ...
,
etomidate
Etomidate (USAN, INN, BAN; marketed as Amidate) is a short-acting intravenous anaesthetic agent used for the induction of general anaesthesia and sedation for short procedures such as reduction of dislocated joints, tracheal intubation, cardiove ...
, and
ketamine
Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppresses ne ...
used to reduce the irritability or agitation of patients, to relieve symptoms of seizure, or provide procedural sedation
*
Paralytic
Paralysis (also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 50 ...
vecuronium
Vecuronium bromide, sold under the brand name Norcuron among others, is a medication used as part of general anesthesia to provide skeletal muscle relaxation during surgery or mechanical ventilation. It is also used to help with endotracheal int ...
Antipsychotic
Antipsychotics, also known as neuroleptics, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but ...
ziprasidone
Ziprasidone, sold under the brand name Geodon among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It may be used by mouth and by injection into a muscle (IM). The IM form may be used for acute agitation ...
, used to sedate combative patients
* Respiratory medications such as
albuterol
Salbutamol, also known as albuterol and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing rel ...
and
ipratropium bromide
Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic (SAMA: short acting muscarinic antagonist) medication which opens up the medium and large airways in the lungs. It is used to treat the symptoms ...
used to treat conditions such as asthma and acute bronchitis
* Steroids such as hydrocortisone and methylprednisolone used to treat inflammatory respiratory conditions and
adrenal crisis
Adrenal crisis is a potentially life-threatening medical condition requiring immediate emergency treatment. It is a constellation of symptoms (caused by insufficient levels of the hormone cortisol) that indicate severe adrenal insufficiency. This m ...
* Cardiac medications such as
nitroglycerin
Nitroglycerin (NG), (alternative spelling of nitroglycerine) also known as trinitroglycerin (TNG), nitro, glyceryl trinitrate (GTN), or 1,2,3-trinitroxypropane, is a dense, colorless, oily, explosive liquid most commonly produced by nitrating g ...
and aspirin are used to treat cardiac ailments such as angina and myocardial infarctions
* Diuretic medications such as
furosemide
Furosemide is a loop diuretic medication used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It may also be used for the treatment of high blood pressure. It can be taken by injection into a vein or by mouth ...
to treat
congestive heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
and severe hypertension
*
Antiarrhythmics
Antiarrhythmic agents, also known as cardiac dysrhythmia medications, are a group of pharmaceuticals that are used to suppress abnormally fast rhythms ( tachycardias), such as atrial fibrillation, supraventricular tachycardia and ventricular ta ...
adenosine
Adenosine ( symbol A) is an organic compound that occurs widely in nature in the form of diverse derivatives. The molecule consists of an adenine attached to a ribose via a β-N9-glycosidic bond. Adenosine is one of the four nucleoside building ...
,
lidocaine
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...
ventricular tachycardia
Ventricular tachycardia (V-tach or VT) is a fast heart rate arising from the lower chambers of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period ...
and
ventricular fibrillation
Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the ventricles of the heart quiver. It is due to disorganized electrical activity. Ventricular fibrillation results in cardiac arrest with loss of consciousness and no p ...
Antidotes
An antidote is a substance that can counteract a form of poisoning. The term ultimately derives from the Greek term φάρμακον ἀντίδοτον ''(pharmakon) antidoton'', "(medicine) given as a remedy". Antidotes for anticoagulants are s ...
for a variety of
toxins
A toxin is a naturally occurring organic poison produced by metabolic activities of living cells or organisms. Toxins occur especially as a protein or conjugated protein. The term toxin was first used by organic chemist Ludwig Brieger (1849–1 ...
such as
naloxone
Naloxone, sold under the brand names Narcan (4 mg) and Kloxxado (8 mg) among others, is a medication used to reverse or reduce the effects of opioids. It is commonly used to counter decreased breathing in opioid overdose. Effects begin within ...
(opioids), pralidoxime (organophosphates), sodium bicarbonate (tricyclic antidepressants), and
hydroxocobalamin
Hydroxocobalamin, also known as vitamin B12a and hydroxycobalamin, is a vitamin found in food and used as a dietary supplement. As a supplement it is used to treat vitamin B12 deficiency including pernicious anemia. Other uses include treatment fo ...
tranexamic acid
Tranexamic acid (TXA) is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation. It is also used for hereditary angioedema. It is taken eith ...
in cases of
hemorrhagic shock
Hypovolemic shock is a form of shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It could be the result of severe dehydration through a variety of mechanisms or blood loss. Hypovolemic shock is a ...
* Broad spectrum
antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
such as
ceftriaxone
Ceftriaxone, sold under the brand name Rocephin, is a third-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. These include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint ...
or
vancomycin
Vancomycin is a glycopeptide antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, ...
for cases of
sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
* Hormones like
oxytocin
Oxytocin (Oxt or OT) is a peptide hormone and neuropeptide normally produced in the hypothalamus and released by the posterior pituitary. It plays a role in social bonding, reproduction, childbirth, and the period after childbirth. Oxytocin ...
to control post-partum bleeding
Skills by certification level
As described above, many jurisdictions have different levels of paramedic training, leading to variations in what procedures different paramedics may perform depending upon their qualifications. Three common general divisions of paramedic training are the basic technician, general paramedic or advanced technician, and advanced paramedic. Common skills that these three certification levels may practice are summarized in the table below. The skills for the higher levels automatically also assume those listed for lower levels.
Medicolegal authority
The medicolegal framework for paramedics is highly dependent on the overall structure of emergency medical services in the territory where they are working.
In many localities, paramedics operate as a direct extension of a physician medical director and practice as an extension of the medical director's license. In the United States, a physician delegates authority under an individual state's Medical Practice Act. This gives a paramedic the ability to practice within limited scope of practice in law, along with state DOH guidelines and medical control oversight. The authority to practice in this manner is granted in the form of standing orders (protocols) (off-line medical control) and direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with independent clinical decision.
In places where paramedics are recognised health care professionals registered with an appropriate body, they can conduct all procedures authorised for their profession, including the administration of prescription medication, and are personally answerable to a regulator. For example, in the United Kingdom, the
Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
regulates paramedics and can censure or strike a paramedic from the register.
In some cases paramedics may gain further qualifications to extend their status to that of a paramedic practitioner or advanced paramedic, which may allow them to administer a wider range of drugs and use a wider range of clinical skills.
In some areas, paramedics are only permitted to practice many advanced skills while assisting a physician who is physically present, except for immediately life-threatening emergencies.
In entertainment
* '' Emergency!'' was a popular 1970s television series which centered on the work of paramedics in the Los Angeles County Fire Department, and the staff at the fictional Rampart Emergency Hospital. ''Emergency!'' has been widely credited with inspiring many municipalities in the United States to develop their own paramedic programs, and acted as an inspiration for many individuals to enter the fields of emergency medicine. The show rated well for its entire production run (1972–77), as well as in syndicated
rerun
A rerun or repeat is a rebroadcast of an episode of a radio or television program. There are two types of reruns – those that occur during a hiatus, and those that occur when a program is syndicated.
Variations
In the United Kingdom, the word ...
s, and inspired a related
cartoon
A cartoon is a type of visual art that is typically drawn, frequently animated, in an unrealistic or semi-realistic style. The specific meaning has evolved over time, but the modern usage usually refers to either: an image or series of images ...
series.
* ''
Mother, Jugs & Speed
''Mother, Jugs & Speed'' is a 1976 American black comedy film directed by Peter Yates. It stars Bill Cosby (Mother), Raquel Welch (Jugs), Harvey Keitel (Speed), and Larry Hagman as employees of an independent ambulance service trying to survive ...
'' is a 1976 comedy film, starring Bill Cosby, Raquel Welch, and Harvey Keitel. The film depicts a private ambulance company struggling to survive in Los Angeles, and gives an indication of the state of the ambulance industry just prior to its increased professionalism.
* ''
Trauma Center
A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major trauma, major traumatic injuries such as Falling (accident), falls, motor vehicle collisions, or gunshot wounds. A trauma cent ...
'' is a 1983 American television medical drama focussing on the McKee Hospital Trauma Center, and two paramedics who had to rescue or save injured people before delivering them to the
trauma center
A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major trauma, major traumatic injuries such as Falling (accident), falls, motor vehicle collisions, or gunshot wounds. A trauma cent ...
.
* ''
Casualty
Casualty may refer to:
*Casualty (person), a person who is killed or rendered unfit for service in a war or natural disaster
**Civilian casualty, a non-combatant killed or injured in warfare
* The emergency department of a hospital, also known as ...
'' is a long-running British
BBC #REDIRECT BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board ex ...
television series (1986–present), depicting the fictional Holby City Hospital's Accident and Emergency Department, and the related paramedics. ''Casualty'' has inspired the
spin-off
Spin-off may refer to:
*Spin-off (media), a media work derived from an existing work
*Corporate spin-off, a type of corporate action that forms a new company or entity
* Government spin-off, civilian goods which are the result of military or gove ...
series, ''
Holby City
''Holby City'' (stylised on-screen as HOLBY CIY) is a British medical drama television series that aired weekly on BBC One. It was created by Tony McHale and Mal Young as a spin-off from the established BBC medical drama ''Casualty'', and pr ...
'', and a number of made-for-television films.
* ''
Paramedics
A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are p ...
'' is a 1988 American comedy film focusing on a group of paramedics in a US city.
* ''Paramedic: On the Front Lines of Medicine'', is a 1988 autobiographical account of a paramedic's first year on the job by Peter Canning. A sequel, ''Rescue 471: A Paramedic's Stories'' was released in 2000.
* '' Bringing Out the Dead'' is a 1999 American drama film, directed by
Martin Scorsese
Martin Charles Scorsese ( , ; born November 17, 1942) is an American film director, producer, screenwriter and actor. Scorsese emerged as one of the major figures of the New Hollywood era. He is the recipient of List of awards and nominatio ...
and starring Nicolas Cage, showing forty-eight hours in the life of a burnt-out hospital paramedic in New York's Hell's Kitchen. The film is based on the novel of the same name by Joe Connelly, a former New York City paramedic.
* ''
Paramedics
A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are p ...
'' is an American
reality television
Reality television is a genre of television programming that documents purportedly unscripted real-life situations, often starring unfamiliar people rather than professional actors. Reality television emerged as a distinct genre in the early 19 ...
show that originally screened from 1999 to 2001, and now runs intermittently on the Discovery Health Channel. The show features the life and work of emergency medical squads in major urban centers in the United States.
* '' Third Watch'' (1999–2005) is an American television drama, parts of which focused on the firefighters and paramedics of the New York City Fire Department.
* ''Shinjuku Punk Rescue Ambulance'' is a 2000 Japanese comedy drama TV series which aired on
Nippon Television
JOAX-DTV (channel 4), branded as , is the flagship station of the Nippon News Network and the Nippon Television Network System, owned-and-operated by the which is a subsidiary of the certified broadcasting holding company , itself a listed su ...
in Japan. The story is about two young Tokyo Fire Department ambulance technicians at Shinjuku West District and working with medical staff of Juniso Hospital. The show is also demonstrating how to deal with various emergency scenarios with first aid techniques at the ending of each episode.
* ''Into the Breach: A Year of Life and Death with EMS'' is a 2002 book written by J. A. Karam, focussing on real-life stories of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies.
* '' Saved'' is a 2006 medical television drama centered on a fictional paramedic, his partner, and their chaotic lives on and off the job.
* ''Black Flies'' is a 2008 American novel written by Shannon Burke, based on his experiences working as a paramedic in
Harlem
Harlem is a neighborhood in Upper Manhattan, New York City. It is bounded roughly by the Hudson River on the west; the Harlem River and 155th Street (Manhattan), 155th Street on the north; Fifth Avenue on the east; and 110th Street (Manhattan), ...
, New York.
* In NBC's sci fi drama ''
Heroes
Heroes or Héroes may refer to:
* Hero, one who displays courage and self-sacrifice for the greater good
Film
* ''Heroes'' (1977 film), an American drama
* ''Heroes'' (2008 film), an Indian Hindi film
Gaming
* ''Heroes of Might and Magic'' ...
'' (2006, 2010), the character Peter Petrelli uses his abilities to save 53 people while working as a paramedic.
* '' Code Blue: Doctor-Heli'' (2008, 2010) is a Japanese television medical drama which aired on Fuji TV Network. It is centered on the lives and work of flight physician trainees with the air ambulance program of the fictional Shoyo University Hokubu Hospital Emergency Center.
* ''
Trauma
Trauma most often refers to:
*Major trauma, in physical medicine, severe physical injury caused by an external source
*Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic inju ...
'' is a 2009–10 American television drama series focusing on a group of
San Francisco
San Francisco (; Spanish language, Spanish for "Francis of Assisi, Saint Francis"), officially the City and County of San Francisco, is the commercial, financial, and cultural center of Northern California. The city proper is the List of Ca ...
Fire Department paramedics working in conjunction with the fictional trauma center of San Francisco City Hospital.
* '' Recruits: Paramedics'' is an Australian television series airing on
Network Ten
Network 10 (commonly known as Ten Network, Channel 10 or simply 10) is an Australian commercial television network owned by Ten Network Holdings, a division of the Paramount Networks UK & Australia subsidiary of Paramount Global. One of five ...
, depicting the work of trainee paramedics recently employed with the
Ambulance Service of New South Wales
NSW Ambulance, previously the Ambulance Service of NSW, is an agency of NSW Health and the statutory provider of pre-hospital emergency care and ambulance services in the state of New South Wales, Australia.
Established pursuant to the and op ...
.
* Denise Sherwood on ''
Army Wives
''Army Wives'' is an American drama television series that followed the lives of four army wives, one army husband, and their families. The series premiered on Lifetime on June 3, 2007, and ran for seven seasons, ending on June 9, 2013. The sh ...
'' was a paramedic, having been a nurse beforehand and a 911 dispatcher later.
* ''F.S.D.'' is a 2011 Hong Kong action-drama TV series which was co-produced by RTHK and the Hong Kong Fire Service Department. It is focused on the work and lives of ambulancemen and firemen in the Hong Kong Fire Service Department. The second episode, "Caring with Love", and fifth episode, "Call for Duty", are centered on the ambulancemen and paramedics particularly.
* ''
Sofia's Last Ambulance
''Sofia's Last Ambulance'' (a co-production of Germany, Bulgaria, and Croatia) is a feature-length observational documentary film by Bulgarian director Ilian Metev. The film premiered at the 51st Semaine de la Critique (International Critics' Week ...
'' (2012) is a feature-length documentary by Ilian Metev about a dedicated ambulance crew in
Sofia
Sofia ( ; bg, София, Sofiya, ) is the capital and largest city of Bulgaria. It is situated in the Sofia Valley at the foot of the Vitosha mountain in the western parts of the country. The city is built west of the Iskar river, and ha ...
,
Bulgaria
Bulgaria (; bg, България, Bǎlgariya), officially the Republic of Bulgaria,, ) is a country in Southeast Europe. It is situated on the eastern flank of the Balkans, and is bordered by Romania to the north, Serbia and North Macedon ...
. The film premiered at
Cannes
Cannes ( , , ; oc, Canas) is a city located on the French Riviera. It is a communes of France, commune located in the Alpes-Maritimes departments of France, department, and host city of the annual Cannes Film Festival, Midem, and Cannes Lions I ...
in 2012.
* ''Elite Brigade'' is a 2012 Hong Kong action-drama TV series co-produced by RTHK and the Hong Kong Fire Service Department after the previous series ''F.S.D.'' succeeded in 2011. The story carries on to tell the work of ambulancemen and firemen in the Hong Kong Fire Service Department. The third episode, "First Responders", is centered on the ambulancemen and paramedics who face a double-decker bus crash during rush hour, with mass victims on scene.
* '' Trauma Team'', a surgery video game for the Nintendo Wii, features a playable paramedic named Maria Torres whose playstyle centers around managing and stabilizing multiple accident victims at once.
* In the game ''Metal Gear Solid 3'', Dr. Clark, nicknamed Para-Medic, dreams of creating a unit of medics able to parachute down to an emergency location.
* ''
Junior Paramedics
''Junior Paramedics'' is a British television series that was first broadcast on BBC Three from 27 February to 8 April 2014. The series follows paramedics on a six-week placement with East Midlands Ambulance Service. The nine junior paramedics a ...
'' is a British television series that was first broadcast on BBC Three on 27 February 2014. The series follows paramedics on a six-week placement with
East Midlands Ambulance Service
The East Midlands Ambulance Service NHS Trust (EMAS) provides emergency medical services, urgent care and patient transport services for the 4.8million people within the East Midlands region of the UK - covering Nottinghamshire, Derbyshire (exc ...
.
* ''
Boston EMS
Boston Emergency Medical Services (Boston EMS) provides basic life support (BLS) and advanced life support (ALS) ambulance units throughout the neighborhoods in the city of Boston, Massachusetts, USA. Boston EMS is a public safety agency respond ...
'' is a medical documentary series which premiered on ABC on July 25, 2015. It follows one of America's most seasoned teams of first responders in Boston, Massachusetts.
* ''Nightwatch'' is a 2015 American reality television show that airs on the A&E channel that focuses on the EMTs and paramedics of the
New Orleans Emergency Medical Services
New Orleans Emergency Medical Services (NOEMS or New Orleans EMS) is the primary provider of advanced life support emergency medical services to the city of New Orleans, Louisiana, United States. Unlike most other emergency medical services in the ...
, as well as the firefighters of the
New Orleans Fire Department
The New Orleans Fire Department provides fire protection and first responder emergency medical services to the city of New Orleans, Louisiana. The department serves 378,715 people living in a area, including of water.
History
The NOFD got its s ...
Ambulance
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
'', a
BBC #REDIRECT BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board ex ...
documentary which first aired in 2016, originally followed paramedics in the
London Ambulance Service
The London Ambulance Service NHS Trust (LAS) is an NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England. The service responds to 999 phone cal ...
Synchronic
Synchronic may refer to:
* ''Synchronic'' (film), a 2019 American science fiction film starring Jamie Dornan and Anthony Mackie
* Synchronic analysis, the analysis of a language at a specific point of time
*Synchronicity
Synchronicity (german: ...
'' is a 2019 science-fiction horror film directed by Justin Benson and
Aaron Moorhead
Aaron Scott Moorhead (born March 3, 1987) is an American film director, producer, cinematographer, editor, and actor. He is best known for his work with creative partner Justin Benson.
Life and career
Moorhead grew up in Tarpon Springs and at ...
that follows two New Orleans paramedics whose lives are ripped apart after a series of horrific deaths are caused by a new designer drug.
Paramedics in Canada
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances p ...
*
Paramedics in France
Emergency medical services in France are provided by a mix of organizations under public health control. The central organizations that provide these services are known as a SAMU, which stands for (Urgent Medical Aid Service). Local SAMU organis ...
Paramedics in the United States
In the United States, the paramedic is a professional whose primary focus is to provide advanced emergency medical care for critical and emergency patients who access Emergency Medical Services (EMS). This individual possesses the complex knowled ...
;Related fields
*
Biophone
The Biophone is a combination voice and telemetry radio communications system used in the 1970s and '80s by paramedics to talk to the physicians supervising them from a hospital base station. The key difference between this unit and another two- ...
*
Field medic
Field Medic is the stage name of American lo-fi music, lo-fi musician Kevin Patrick Sullivan.
History
He began releasing music with his older brother Sean in 2009, initially as Westwood & Willow and then with drummer Andrew Skewes-Cox as Rin Tin ...
*
Flight Paramedic
A flight paramedic is a paramedic who provides care to sick and injured patients in an aeromedical environment. Typically a flight paramedic works with a registered nurse, physician, respiratory therapist, or another paramedic. Flight paramedics m ...
List of EMS provider credentials
An EMS provider's post-nominal (listed after the name) credentials usually follow his or her name in this order:
* Highest earned academic degree in or related to medicine, (e.g. "MD")
* Highest licensure or certification (e.g. "NRP")
* Further ...
References
Further reading
* Conaghan, Joseph. ''Coach and horses: my history in the ambulance dispute 1989/90''. Glantaff House, 2010.
*
*
*